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Women's Physical Health After Childbirth: Do Violence and Depression Histories Represent Risk Factors for More Postpartum Physical Health Symptoms?

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Women's Physical Health After Childbirth: Do Violence and Depression Histories Represent Risk Factors for More Postpartum Physical Health Symptoms? WOMEN'S PHYSICAL HEALTH AFTER CHILDBIRTH: DO VIOLENCE AND DEPRESSION HISTORIES REPRESENT RISK FACTORS FOR MORE POSTPARTUM PHYSICAL HEALTH SYMPTOMS? Donna Lynn Ansara A thesis submitted in conformity with the requirements for the degree of Masters of Science Graduate Department of Health Administration University of Toronto @ Copyright by Doma Lynn Ansara 2001 National Library Bibliothèque nationale 1*1 ofChad, du Canada Acquisitions and Acquisitions et Bibliographie Services services bibliographiques 395 Welington Street 395. rue Wellinglori OltawaON KIAOW OüawaON KlAON4 canada Canada The author has granted a non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies of this thesis in microfonn, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/film, de reproduction sur papier ou sur format électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantiels may be printed or othenvise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. ABSTRACT Women's physical health after childbirth: Do violence and depression histories represent risk factors for more postpartum physical health symptoms? Donna Lynn Ansara, Masters of Science, 2001 Graduate Department of Eealth Administration, University of Toronto A prevalence study was conducted to document the extent and the correlates of cornrnon postpartum physical health symptoms, and to determine whether violence and depression histones were associated with these symptoms. Women were recruited in the hospital after delivery and were interviewed by telephone 8 to 10 weeks later. Data were also obtained fiom women's medical records. Two hundred of the 332 (60.2%) women who were approached completed the study. Most women (96%) reported at least one physical symptom. The nsk factors identified by the stepwise logistic regression were: assisted vaginal delivery @ = 2.04; 95% -CI = 1.26 - 3.29), sick leave during pregnancy (RR = 1.92; 95% -CI = 1.1 1 - 3.33), depression during pregnancy (R.J = 2.0 1 ;95% -CI = 1.20 - 3.38), and possibly adult emotional abuse (RR = 1.57; 95% -CI = 0.97 - 2.56). Postnatal physical symptoms are common. Practice implications for health professionals are discussed. 1 would sincerely like to thank my cornmittee members for their guidance and contribution to this thesis. Dr. Marsha Cohen who supervised this project, providing invaluable mentorship and support throughout and for encouraging the timely completion of this thesis. Dr. Ruth Gallop for providing thought-provoking feedback on the framing of the thesis and Dr. Rose Kung for contributing her obstetrical expertise. 1 am also gratefbl to Dr. Marsha Cohen and Dr. Heather Maclean for providing fhding support, space, and cornputer availability through the Centre for Research in Women's Health. 1 would also like to thank the research staff who worked on this project. Finally, 1 am indebted to the women who generously volunteered their time to participate in this study and who shared many of their difficult personal expenences. TABLE OF CONTENTS .. ABSTRACT .................................................................................................................................II ... ACKNOWLEDGEMENTS .........................................................................................................111 TABLE OF CONTENTS............................................................................................................. iv LIST OF TABLES .......................................................................................................................v LIST OF APPENDICES ..............................................................................................................vi INTRODUCTION .......................................................................................................................1 1.1 Smdy rationale ................................................................................................................ 1 STUDY OBJECTIVES ................................................................................................................ 4 BACKGROUND ........................................................................................................................ -5 2.1 Critique of medical understanding of materna1 health .................................................... 5 2.2 Theoretical hmework for the present shidy ..................................................................8 2.3 Epidemiology of postpamim materna1 physical symptoms ............................................9 2.4 Studies of specific postpartum matemal physical syrnptoms ......................................... 13 2.5 Violence and health ......................................................................................................... 17 2.6 Depression and health .....................................................................................................29 2.7 Other factors................................................................................................................... -35 2.8 Literature review of instruments used in the smdy ......................................................... 39 2.9 Surnrnary .........................................................................................................................43 METHODS ................................................................................................................................. -44 3.1 Study design .................................................................................................................... 44 3.2 Study setting .................................................................................................................. -44 3.3 Participantsr .' ..................................................................................................................... -45 3.4 Procedure ............................. ., ........................................................................................ 47 3.5 Instruments...................................................................................................................... 49 3.6 Research ethics and participant confidentiality ............................................................36 3.7 Statistical Method ........................................................................................................... 59 RESULTS ................................................................................................................................... -80 4.1 Response rates .................................................................................................................80 4.2 Characteristics of the study participants ......................................................................... 82 4.3 Cornparison of respondents and non-respondents .......................................................... 82 4.4 Cornparison of the respondents to the population........................................................... 84 4.5 Statistical Analysis .......................................................................................................... 85 DISCUSSION .............................................................................................................................. 98 5.1 Summary and interpretation of the findings ...................................................................98 5.2 Methodological issues ..................................................................................................... 107 5.3 Strengths and limitations of the smdy ............................................................................ 10 5.4 Implications of the study findings ..............................................................................112 5.5 Directions for fbture research ................................................................................... 115 FOOTNOTES ..............................................................................................................................118 REFERENCES .........................................................................................................................119 TABLES ...................................................................................................................................... 135 APPENDICES .............................................................................................................................161 LIST OF TABLES Table I Characteristics of the Study Participants .............................................................136 Table II Cornparison of Respondents and Nonrespondents ............................................. 138 Table III Construct Validity of the Outcome Variable .......................................................141 Table IV Number of Postpartum Somatic Symptoms......................................................... 142 Table V Prevalence of Postpartum Somatic Symptoms .................................................143 Table VI Prevalence of a History of Violence ....................................................................144
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